Provider Demographics
NPI:1043993439
Name:BRYANT, LISA CAROL (MSN,FNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CAROL
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MSN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HAMILTON AVE APT A
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-4650
Mailing Address - Country:US
Mailing Address - Phone:423-736-5885
Mailing Address - Fax:
Practice Address - Street 1:114 HAMILTON AVE APT A
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4650
Practice Address - Country:US
Practice Address - Phone:423-736-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily